A Health Insurance CEO Who's Bringing Apps To Affordable Care

If you’ve lost faith in the government’s effort, Aetna’s Mark Bertolini could be the guy who gives you hope that the health insurance industry will indeed improve. A top exec with the healthcare giant since 2003, and at the helm since 2010, Bertolini exemplifies this week’s Techonomy 2013 conference theme, “Leaders must think more like technologists.”

Under his leadership, Aetna is nurturing the development of apps to improve the quality and cost of healthcare, is advising the Obama administration on fixing Healthcare.gov, and, as a New York Times story illustrated last year, has even engaged directly with customer feedback on Twitter.

But those aren’t the only things that make Bertolini extraordinary in the insurance industry. Sporting several prayer-bead bracelets and a gold charm with the Sanskrit phrase Soham—“I am that”—under his starched white collar, the 56-year-old CEO joined Techonomy’s David Kirkpatrick on stage for a frank discussion about the future of health insurance and health care, and well as his own recent family medical history.

Bertolini says he uses alternative approaches including yoga, acupuncture, meditative chanting, and craniosacral therapy—considered quackery by many mainstream medicine practitioners—instead of pharmaceuticals to tolerate chronic pain he has suffered since breaking his neck in a 2004 skiing accident. A former paramedic, Bertolini had, three years earlier, so intensely advocated for his son’s care for a rare, incurable cancer that the teenager became the first known survivor of the disease and is a healthy 28-year-old today.

He says it was “frightening to watch the disconnected nature of how the healthcare system works,” and came away from the experiences convinced that the industry needed to be “creatively destroyed.”

He acknowledges what an immense challenge that is for a company like Aetna. “We’re 163 years old. We’ve been underwriting risk for 163 years, and the formulas haven’t changed in 163 years. Some say we have actuaries who have been around for 163 years. It’s difficult moving the model.”

The Affordable Care Act, he says, has “broken up the black box of managed care insurance.” His response: “to take small pieces of the company’s services and repurpose them into other parts of the value chain.” On the healthcare delivery side, he says, Aetna has developed apps that allow providers “to take risk and be in our business.”

“We’re doing a lot about connecting high tech with high touch, and looking at ways we can intervene,” Bertolini says. One example is experiments with a concierge service that resulted in a 49 percent reduction in hospital readmissions for congestive heart failure. The service asks cardiac patients to step on a wi-fi scale and use a blue tooth technology to monitor arterial impedance. Signals of a slowed heart and retained water alert a remote nurse to visit the patient at home, adjust medications, and roll up the rugs so a cardiac patient who is dragging his feet won’t trip.

Another example is the free iTriage app, which lets consumers manage their own health information, including keeping track of medicines prescribed by various physicians.

He also points to Healthagen, a business created by Aetna and run by Chuck Saunders to invest in and incubate innovative businesses addressing healthcare needs in order to offer an integrated suite of tools designed for providers, employers, payers, and consumers to improve care and control costs. Bertolini says the company has almost 200 technology products in its pipeline that could generate upwards of $1.5 billion in revenues in the next year.

On the consumer side, he says, the company is driving customers to adopt apps with a carrot-and-stick approach. “Today, consumers contribute 41 percent of the healthcare dollar,” Bertolini says. “As soon as that hits 50 percent, we will have a very different marketplace." To address that forthcoming consumer-driven market, last month Bertolini created a Consumer Products and Enterprise Marketing organization under the direction of Dijuana Lewis, formerly Wal-Mart’s senior VP of healthcare solutions.

Perhaps a more significant change for the company and the industry is what Bertolini describes as a redefinition of health. He says the industry needs to move away from impulsively trying to cure diseases—“It’s a Pavlovian response; someone’s sick, fix it, get paid”—to helping individuals be productive and economically viable. “The goal is to make people healthy so they’re productive,” he says. His philosophy: Health is an economic contributor to communities; an economically viable person is a happy person, and happy people living in communities together would make for a different world. Getting patients there, he says, would include “reintroducing integrative medicine into the normal routine of taking care of people.”

Bertolini is his own case-in-point. With use of one hand compromised ever since the nerves in his arm were torn from his spinal chord, he says, “I am not the optimal state of health that one would put the average human being as having, since my accident, but I am at the best I can be and still live a very productive and vibrant life.”